| NPI | 1306531074 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: MN 82732) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: WI 87817-20) |
| Enumeration Date | 2023-04-10 |
| Last Update Date | 2026-07-28 |